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Ms. Toad

(38,824 posts)
Sun Aug 17, 2025, 10:13 PM Aug 2025

Oh crap. Let's turn Medicare into Medicare Advantage.

One of the things on the list is a skin substitute. It was just before I was on Medicare, but I had to fight with an insurance company for a cadaver graft to cover my 5" diameter open wound for 3 weeks while pathology minutely examined the aggressive cancer they removed, to be sure they didn't need to do 2 autografts, in case they hadn't gotten it all. It actually didn't require prior authorization - it was a coding error, but it is something I am intimately familiar with.

Prior authorization would have required delaying surgery for an aggressive tumor which doubled in size in about 2 weeks.

The things which currently require prior authorization, by and large, are things which are both cosmetic and functional (For example, my spouse's vision was limited by her eyelids drooping into her line of vision - so the reason she had the surgery to remove part of her eyelids as medical. But my SIL wants to have it done for cosmetic reasons. That surgery requires prior authorization.) The things they are talking about now are not frequently abused procedures.

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